PRE 2010 DOCS0Cit3' oFridley, f FMinn. 0
BUILDING PERMIT N? 4466
Date:'-L.1._'r-S�--(1.__.___
Owner:Builder--------•------- -----......................... ... —................
- --......_ _....
Address.1...---•-
- - . — Address...................................A 0 --------------------------------------------------------------
J/ LOCATION OF BUILDING
No.•{1...... Street ..-�......._......1f................ _......... .. Part of Lot -... - _............._............. _
Lot /P ................ Block ............. ...._............................. . Addition or SSub-Division .....1� - �
Corner Lot .................................... Inside Lot ............... Setback....J.�'r1......................... Sideyard /15 .......... -....4 ............... _.......
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: t
6Type_.. ....._..-- ---. Front ..--%. Depth ... _.. Height _ _...... Sq. Ft. �. VOCu. Ft.I..---._.._... Front .... ..` ....-. Depth .. .... Height .._ [� .... Sq. Ft. -,�30-A �. C`u. Ft. f Construction ....��!..-- Est. Co././�P._` . To be Completed ............ ............................
9 U P !0 N
THIS PERP/1:T D, -,El; LIOT AYTHORIZE VIOLAT-
ION OF ANY P, 5j,, A (E LA ', D COVENANTS AND
f3U:LDf"G Rc' i 11211 TICP'J .
In consideration of the issuance to me of a permit to construc he building described above, I agree to do
the proposed work in accordance with the description above set than�ihwnc ph ce wi a rovisions of
ordinances of the city of Fridley.
........ _..... -._........._.._.._ ..__ ...._......_ .......__.._.._..._....
In consideration of the payment of a fee of $......, permit is hereby granted to.........................................................
._.._-._............................ ._............. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violatio f any of the provisions of said
ordinances.
_..._.. .. ... .._......._.f ..... -....._...._ ._ Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
M
APPSWOon for Power Plants and Heciting. Cootg
in , Ventilation Reftigenition and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII, 4-7470
GRAVITY WARM AIR: RATE TOTAL, Location
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
Repairs & Alterations—up to $500.00 .................. 5.00 $ specified, agreeing to do all work in strict accordance with the City Ordinances
Repairs & Alterations each add. $500.00 ............... 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application true ano correct.
MECH. WARM AIR Fridley, Minn 19
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 dw 6
each add. 60,000 BTU ........ 2.00 $ Owner
Replacement of Furnace x.00 $ Kind of Building
Repairs & Alterations—up to $500.00 ...:e ............ 5.00 $ `
Used as
Repairs & Alterations each add. $500.00 ....... :...... 2.50 $®`
To be completed about
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam...... 8.00 $ Estimated Cost, $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Old—New. Building Permit No. 15t�& Permit No. �S
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. IDR Hot Water .................. 2.50 $ DESCRIPTION OF WORE
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$
ROUGH
FINAL
HEATING or PO PZANTS--Steam, Hot Water, Warm Air—No �
Trade Name '7 = � r/ Size N�g
Capacity 99- Sq. �,W
Ftt.EDR BTU H.P.
Total Coecieii Lo7/ Rind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
. az 2M 7-59x:-
Qa.
Application for Power Punts and Healing, Cooling, Ventilatim, Refrigerafion and
Air Conditioning Systems and Devicesa
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
4
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $ _
Replacement of Furnace .............................. .0.00 $
Repairs & Alterations—up to $500.00 ... ............ 5.00 $
Repairs & Alterations each add. $500.00 ....... :....... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDA Steam....... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
00
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
Dept. of Bldgs. Phone SU. 4-74700(i f j�
Location .�����
City of Fridley: _
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, inn y—Ir 1960
Owner �i? ! e aza('r-�'XS'_
Kind of Building t
Used as
To be completed about e '`
Estimated Cost, $ 10017. 0
Old—New. Building Permit No. Permit No.T
r
DESCRIPTION OF WORK
HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No
Trade N Size No
Capacity Sq. Ft. E.D.R. BTU H.P.
Total Connected Load Sind of Fuer
BURNER — Trade
Size No
Capacity Sq. It. E.D.R BTU H.P.
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $ �:� Signe �f
By
k� Ak
ROUGH
42 TM 7-59 Business Phone No «- �b
FINAL
(REMARKS—OVER)
City of Fridley; Minn. N° 7912
BUILDING PERMIT
•
Date: June 17, 1965
Owner: Sheldon Benjaminson Builder same (owner)
Address 5811 4th .Sit. N.H' • Address
LOCATION OF BUILDING
NAO90 583 8t 4th St. NA. Part of Lot
,at 10 _ Block 5 Addition or Sub -Division Bennett Palmer
Corner Lot Inside Lot
Sewer Elevation
To be Used as:
Type of Construction
Front
Setback — Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Depth Height Sq. Ft.
Front Depth Height Sq. Ft.
Fust. cost _.5#000 _ To be Completed
• Repair storm damage
•
cu.. Ft.
Cu. Ft.
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with Z provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 10:00 , permit is hereby granted to Sheldon
B2njaminson to construct the building or addition as described above. This permit is granted upon
the express oandition that the person to whom it is granted and his agents, employees and workmen, in all work
done around and upon said building, or any pari thereof, shall conform is all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
A71en Jensen Building Inspector
NOTICE:
"k perm@ den amt causer the condruedon, huhUatlon for robing, phmbtug, gn busing, ewer or water. Be sun to on
the BWMW lwpu r for separate peeadta for these hexa.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME��✓i'�
ADDRESS_ '_ --2 y� �� �i! /� ADDRESS
LOCATION OF BUILDING
No. Street Part of Lot
LOT d BLOCK ADDITION OR SUBDIVISION
Corner Lot Inside LOT Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height,
Sq. Ft. Cu. Ft.
Front Depth T_Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cos `%"" D
To be completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
and rulings of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct..
DATE - # SIGNATURE
(Schedu a of Fee Costs can be found on the Reverse Side).
UI r Uf I-Rll)Lki INSPECTION DIViSION
6431 University Ave NE
Fridley; MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
CM3 -572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement) ,
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 0
$ 10.00 $
$ 10.00 $
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
1 6 9 66S -7 -)
Effective On January 1, 2001
BUILDING USED AS
ESTIMATED COST PERMIT f
PERMIT N0.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One' (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work, in strict accordance with the City Codes an
.50 rulings of the Building Division,and hereby declares that all the facts and
$ representations stated in this application are true f nd correct.
DATE
HEATING COLS
Signed\ --'l A TEL #
Approved By Rough -In Date Final Date
BACK SIDE MUSTWE, FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
COMMON VENTVENTCONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
Yes ( ) No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
Yes ( ) No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturers specifications.
Yes () No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes () No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( )No(
)
Appliance Type and Sizb/Common Vent and Vent Connector Information
Appliance #1 Typ QBTU Input`30� Fan Assisted or Nat
Appliance #2 Type mCAN BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING
Signed By,
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604 }
PLUMBING FIXTURE RATES:
Urinal
1a31o3 - X
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Wash Dank Floor Catch..;' Auto,
Shower Smk Tray Fount Drain Basin Washer
NO. MTE
TOTAL
NewFixtures
$ 7.00
.Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader _
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas**
$10.00
Gas'Ran ge**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
$ .50
Effective On January 1, 1999
Gas M�sC.:.i? Water Heater
Range I'Fikt'*
,: ;> Gas Elec
Q
OB ADDRESS ®I I N
p®S
i,
e undersigned hereby makes application for a perm it for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Building Used As
Estimated Cost PERMIT NO.
PLUMBING COMPANY_ AACGIIIRE 8 SONG r
. 605 12ti: Avetlut South a
SIGNED BY �OpklnS; eVIN 5.� NN ., -931 9
Approved By. Rough—In Date Final Date
j� MINIMUM FEE FOR ANY PLUMBING/
50 PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VFNT,V NT CONN CTOR ANn COMR11STION AIR V RIFI CATION
When replacing an existing.furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes (i No ( )
The venting system is plasbc/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (i No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () 'No ( )
The Axis ing cnmhustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to instill a new comhustinn air,,it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a n _w v _nting -rzyc_tem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( )No(
)
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter _in-. Type
HEATING CO:
Signed By: Date :
" L&L.L% L6 B V 1L11LV U Permit N a
Inspections RESIDENTUL APPLICATION Rweived 13y:
763-572-3604 CIT' -Y' OF FRYDLE�' n A
763-502-4977 FAX I ,�,�,O,�,,,mro , , �„ 9
DATE—Q - of 6
SITE ADDRESS
THIS APPLICANT IS:
TENAN"K'
YOUR E-MAIL
r
❑ OWNER *ONTRACT'OR
ADDRESS: ✓v k C11Y STATE ZIP
PHONE:— y .OGS
SUBMIT A COPY OF
'YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
STATE LiC6NSE f!
ADDRESS: 10"7 ��l / q r51
PHONE 76 3 - I S�
PROPERTY TYPE
tSINGLE FAMILY
❑ TWO FAMILY/NEW CONSTRUCTION
PERMIT ME
O ADDMON O GARAGEIS
O BASEMENT FjNISH q ROOF
❑ DWK 0 SIDING
C! SWIMM1N(
T'1C1PE OF WORK:
❑ NEW HOME CONSTRUCTION ❑
❑ MA1NTENANCE/REPAIR `n
DESCRIBE WORK BEING DONE: D i)E d
SIZE OF IMPROVEMENT
LENGTH
17 HOUSE ONLY
NUMBER Of SQUARES
i7 HOUSE & GARAGE
[3 ATTACHED GARAGE
PRO SIZE:
❑ DETACHED GARAGE
PROPOSED HEIGHT:
S AVG
❑ Virryl
usoft"tt
❑ Aluminum
❑ Trim
❑ Other
4 Fascia
E7CP DATE
SUN TY
FAX
SIZE,
STORIES
HEDDOwS
❑ DRAW TILE
❑ OTHER
iPOOL
ADDITION
MODELING
Lyd0,4;s
WIDTH TmprC.0 r
VnNDOWS
IN EXISTING OPENINGS We$ UNo LOCATION Of 'WINDOWS
OR FOR NEW OPIrNINGS-DESCRIBE SIZE OF
OPENINGr CHANGES & 4,
TYPE OF WINDOW TO BP INSTAL ED�ENUNBEROFWFNDOWS !
ALL FEES ARE BASER ON vALuATroN, INCLUDING THE COST OF
US�TG THE 1997 K1'AC FEE SCHEDULE)
TOTAL .IO1$ VALUATION $ CJ OCCUP,
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Club Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TES'
BASEMENT RMdQpff &G SUBMIT:
i. Existing Floor Plan
2. Proposed floor plan
3. List of sauctwral members to be used
FOR NEW CONSTRUCTION INCLUDING DLCKS,
AD=QN& & PORCHES SUBMIT:
I . Site PlanlSurvey showing the existing Muctures
and proposed project
2. Two sets ofoonstruction plans
1 Energy Calculations
AND MA
See Rack Page for Fee Schedule
65% of Building Permit Pee
.001 times the total job Valuation
.0005 x Permit Valuation Minimum} $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (plans to MWCC for determination)
ft+6ft= iixS21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Matte cheats payable to: City of >FridleV Attac
THIS 19 AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and aomnte; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application a work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the Case ofal o hi uires review and approval of plan&
SIGNATURE OF APPLICANT PRINT NAME 62 DATE
Wb 99:6Z:6 600Z/tiZ/£ :91,80 b2 :86ed 9069 9 6£ £9L :wa4